Summer Registration Form

Student Name (required)

Student Address

Academic School

Date of Birth
Gender

Race(For statistical reporting only)

Emergency Contact:

Please specify any special conditions / medical needs that we should be aware of.

New or Returning Student?

Select Semester

Select Class(es)
(Select as many as you'd like by holding down control on your Mac or shift on your PC)

Name Parent or Guardian 1 (required)



Home Phone
Cell Phone
Employer
Work Phone
Your Email (required)
(We send important school information via email*)

Name of Parent or Guardian 2
Please fill out any information that is different than Parent 1

Address


Home Phone
Cell Phone
Employer
Work Phone
Your Email

Please send all billing and informational mailings to:

**Campers Only!** Ride permission
Please list any person(s) that has permission, aside from the parent or guardian, to pick up your dancer up from camp. If they are not listed here they will not have permission to take your dancer home unless staff is notified of an additional driver.

Name1
Phone1
Name2
Phone2

How did you hear about us?

Other:

Liability Waiver

I am aware that dance is a physical activity that carries the risk of injury. By signing this waiver, I am releasing Dance Project and any and all of its employees, City Arts and City of Greensboro from all liabilities associated with injuries sustained during dance classes or related school functions.

Accept

Publicity Release
I agree to allow the above named student to be photographed and/or videotaped for use by Dance Project, City Arts, Greensboro Parks and Rec/City of Greensboro. I understand this release will not expire and shall be used for publicity and public relations.

I have read and agree to the Dance Project's Policies and Procedures (FAQ).
Yes, I have read the Policies